Darlington County School District

ADMINISTRATIVE REFERENCE FORM

Applicant Information:Reference Information:

Applicant Name:

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Reference Name:

Address:

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Address:

City/State/Zip:

/ City/State/Zip
Telephone: / Telephone:

I, the undersigned, waive the right to review this reference form.

Applicant’s SignatureDate

Please rate the applicant on the following skills, abilities and knowledge using the following scale: HIGH LOW

(Please check one) 5 4 3 2 1

Willingly claims the role of leader and serves as an example to others
Possesses inner drive which continuously propels him/her to make things happen and get things done
Has the courage to ask for action and is persuasive enough to solve problems in a positive manner
Takes charge of critical situations and makes firm, quick decisions
Accepts personal responsibility for consequences of his/her actions
Takes responsibility for performance of those persons he/she supervises
Committed to the encouragement and development of students and teachers so that they can be successful
Arranges people with an environment so that they can be successful
Understands and works successfully with a wide range of people from diverse backgrounds to achieve
“win-win” outcomes
Shows caring and concern for co-workers and is readily available for consultation
Organizes well and motivates people to accomplish goals while creating a sense of order and direction
Identifies actions necessary to complete tasks and obtain results
Knows how to manage, set performance objectives and measure progress
Analyzes all aspects of a situation to gain thorough insight to make decisions in a timely manner
Prioritizes and completes overlapping tasks in order to deliver desired outcomes within allotted timeframes
Demonstrates ability to make unpopular and difficult decisions to achieve results
Follows through on commitments and decisions to achieve results
Builds trust with others and is able to cooperate with other team members to meet objectives
Able to create positivity, excitement, and good feelings in the organization
  1. How long and in what capacity have you known this applicant?

  1. What is this applicant’s greatest strength?

  1. In what area(s) would the applicant need support, remediation, training, etc? Please support your opinion.

Applicant Name:

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Reference Name:

Please check the statement which best describes your opinion about this applicant for an administrative/instructional support position.

This applicant is a proven leader in every sense of the word. He/she has initiated or accepted leadership roles and has been successful. I would rate him/her in the top 10% of administrative applicants.
This applicant has great potential to be a leader. He/she has the training and experiences to make this a reality.
This applicant has taken coursework in administration, but I have not observed him/her in any significant leadership role. I would suggest additional leadership opportunities.
This applicant has had some leadership opportunities. I would suggest that he/she might need to improve in the area(s) noted in # 3 above.
I am aware of past leadership experiences of this applicant and have reservations about him/her pursuing other leadership positions.
No comment.
Other:
May Darlington County School District contact you should we have any further questions? / Yes / No

Signature of ReferenceCurrent TitleDate

Please return to:Darlington County School District

Department of Human Resources

120 East Smith Avenue

Darlington, SC 29532

843.398.2303 (Tel)

843.398.5006 (Fax)

AN EQUAL OPPORTUNITY EMPLOYER

The DarlingtonCountySchool District will provide equal employment opportunities to otherwise qualified individuals without regard

to race, color, religion, gender, age, disability, national origin, or genetic information.

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(1/2015)